An Institute of Medicine report issued yesterday and reported on at Kaiser Health News concluded that while "there are wide discrepancies in access to and quality of care across geographic areas, particularly for racial and ethnic minorities,” these variations do not appear to be due to Medicare payments and were unlikely to be influenced by changes in rates.

The committee concluded that Medicare beneficiaries in some geographic pockets face persistent access and quality problems, and many of these pockets are in medically underserved rural and inner-city areas. However, geographic adjustment of Medicare payment is not an appropriate approach for addressing problems in the supply and distribution of the health care workforce. The geographic variations in the distribution of physicians, nurses, and physician assistants and local shortages that create access problems for beneficiaries should be addressed through other means.

The alternative solutions put forth in the report include having Medicare pay for services such as telemedicine that improve access to medical care in underserved regions. Another poposal was to encouraged states to change scope of practice laws so that nurse practitioners can provide more care, something the institute has pushed for in the past.